Parathyroidectomy does not correct hypertension in patients on maintenance hemodialysis.
Both hypertension and secondary hyperparathyroidism (2 degrees HPT) are common features of the uremic syndrome. It has been suggested that 2 degrees HPT causes hypertension in end-stage renal disease (ESRD). We compared predialysis blood pressure (BP), weight and dose of antihypertensive medications (AHM) prescribed in 19 hemodialysis patients 1 month before total parathyroidectomy (PTx), during the first month after PTx, and long-term (mean 16 months) in 12 of 19 patients. At the time of PTx, study patients had a mean age of 47 +/- 9 years, mean duration of ESRD was 112 +/- 57 months, and mean intact parathyroid hormone (PTH) level of 1,181 +/- 552 pg/ml. Mean BP and predialysis weight were equivalent during the month before and the month after PTx. Of 12 patients followed long term, 8 (67%) were receiving AHM before PTx; after PTx; 3 (36%) of 8 discontinued AHM within 1 year, 2 (25%) of 8 required more AHM, while 2 (25%) of 8 continued on their original AHM, and 1 patient who was not on AHM prior to PTx required initiation of AHM after PTx. There was a clinically significant increase in predialysis weight at 1 year after PTx (median 13 lb) and over time (r = 0.7; slope = 0.5; p = 0.07). However, there was neither a clinically nor statistically significant change in either systolic (r = -0.18; slope = -0.01; p = 0.61) or diastolic (r = -0.6; slope = -0.24; p = 0.12) BP over time. We conclude that PTx fails to correct hypertension in hemodialysis patients with 2 degrees HPT.
Ifudu
O
O
Department of Medicine, State University of New York Health Science Center, Brooklyn 11203, USA.
Matthew
J J
JJ
Macey
L J
LJ
Hong
J S
JS
Sumrani
N
N
Sommer
B G
BG
Friedman
E A
EA
D000328:Adult; D001794:Blood Pressure; D001835:Body Weight; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000209:etiology / Q000601:surgery; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D006435:Renal Dialysis
D010281:Parathyroid Hormone